Background

Typhoid fever is a potentially fatal illness common in the less industrialized world.

In the United States, the majority of cases occur in travelers to other countries.

Methods

We reviewed surveillance forms submitted to the Centers for Disease Control and Prevention, Atlanta, Ga, for patients with culture-confirmed typhoid fever between 1985 and 1994.

Results

The Centers for Disease Control and Prevention received report forms for 2445 cases of typhoid fever.

Median age of patients was 24 years (range, 0-89 years).

Ten (0.4%) died.

Seventy-two percent reported international travel within the 30 days before onset of illness.

Six countries accounted for 80% of cases :

Mexico (28%),

India (25%), the Philippines (10%),

Pakistan (8%),

El Salvador (5%), and Haiti (4%). The percentage of cases associated with visiting Mexico decreased from 46% in 1985 to 23% in 1994, while the percentage of cases associated with visiting the Indian subcontinent increased from 25% in 1985 to 37% in 1994.

The incidence of typhoid fever in US citizens traveling to the Indian subcontinent was at least 18 times higher than for any other geographic region.